Dvorak v. Montana State Fund [07/30/13] 2013 MT 210 The Montana Supreme Court held that the question of when Petitioner knew or should have known that she was suffering from an occupational disease was not amenable to summary disposition where Petitioner’s treating physician testified that he did not conclude that Petitioner had a specific pathological condition until December 2010 and did not conclude she had an occupational disease until March or April 2011, when he informed Petitioner of his conclusion, after which Petitioner timely filed her claim for benefits. Although Petitioner conceded that she knew she suffered from a repetitive motion condition as far back as February 2006, the WCC failed to take the doctor’s testimony into account and incorrectly granted summary judgment where a material question of fact remained.

Siebken v. Liberty Mut. Ins. Co. [10/21/08] 2008 MT 353 The claimant incorrectly asserts that he had up to 12 months to provide his employer with notice from the date the claimant learned of the nature of his injury; the 12-month time limitation which arises in § 39-71-601, MCA, requires that employees file claims for compensation within 12 months from the date of an accident. The 30-day statute of limitations for providing employers with notice of the accident is a separate and distinct statutory time requirement.

MONTANA WORKERS' COMPENSATION COURT DECISIONS

Spencer v. Montana Schools Group Ins. Authority [06/10/15] 2015 MTWCC 12 Summary judgment was proper where, even assuming that the two-year statute of limitations for filing a claim after benefits were denied was tolled during the pendency of the second mediation, the mediation process was concluded on the twenty-fifth day after mailing the mediator’s second report, which was well over a month before the Petition for Hearing was filed.

Dvorak v. Montana State Fund [05/05/14] 2014 MTWCC 11 Where neither Petitioner nor her treating physician put any thought into the cause of her symptoms, and Petitioner’s treating physician did not question whether a more aggressive approach to diagnosis and treatment was warranted, the Court held that Petitioner first knew or should have known that she suffered from an occupational disease on the day that her treating physician referred her to a specialist and took her off work.

Dvorak v. Montana State Fund [05/05/14] 2014 MTWCC 11 Since the Montana Supreme Court has held that the use of pain mediation “cuts both ways” in considering whether a claimant should have known she had an occupational disease, the Court found little, if any, probative value in the fact that Petitioner used Tylenol 3 to reduce her work-related pain for years prior to her formal diagnosis.

Monroe v. MACO Workers Comp Trust [03/17/14] 2014 MTWCC 7 Both Petitioner and her deceased husband believed the husband’s asbestos-related disease (ARD) arose from the many years he worked for W.R. Grace. After Petitioner’s husband died, her attorney found an industrial hygienist who explained how her husband was exposed to asbestos while on the county road crew, and a physician established that the husband’s ARD was more probably than not significantly impacted by his work for the county. The Court concluded that Petitioner could not have known that the county was the last employer to injuriously expose her husband to asbestos-causing disease until informed by her attorney, and her claim was not time-barred pursuant to § 39-71-601(1), MCA.

Romine v. Northerwestern Energy [10/17/12] 2012 MTWCC 35 The statute of limitations begins to run when a worker knows or should know that he suffers from an occupational disease, as set forth in § 39-71-601(3), MCA. The Court rejected Petitioner’s argument that the statute of limitations should not begin to run until the worker knows or should know that his employment is the leading cause contributing to the result. The “major contributing cause” analysis goes to whether a condition is compensable as an occupational disease – not whether a worker knew or should have known that he suffers from an occupational disease.

Romine v. Northerwestern Energy [10/17/12] 2012 MTWCC 35 Where Petitioner received both diagnoses and treatment for his shoulder and low-back complaints, the Court concluded that he should have known by that time that these conditions resulted from an occupational disease, thereby triggering the statute of limitations under § 39-71-601(3), MCA. Conversely, since Petitioner did not receive a diagnosis or treatment for his cervical condition until nearly a year later, the statute of limitations for that condition did not start to run until diagnosis or treatment triggered it.

Morse v. Liberty Northwest Ins. Corp. [05/03/12] 2012 MTWCC 16 Although Petitioner’s time-of-injury employer apparently created an incident report for Petitioner’s industrial accident, the parties could not find the report and no one testified that Petitioner had signed it. Therefore, the Court concluded that the missing report did not fulfill the requirements of § 39-71-601, MCA.

Tinker v. Montana State Fund [07/07/08] 2008 MTWCC 33 The WCA no longer has a general definition of “disability” for reasons that are unclear from the legislative history. However, the legislature clearly made a concerted effort to revise all the statutes which reference some sort of “disability” so that they require a wage loss or inability to perform one’s time-of-injury job as an element of each definition. In the present case, where Petitioner had a commonplace slip and fall accident and missed no work, and assumed that the residual aches and pains would heal over time, and where he subsequently sought medical treatment only when his pain reached a level where he had difficulty performing his job duties, Petitioner lacked knowledge of his disability until he sought treatment because of his inability to perform his job duties.

Tinker v. Montana State Fund [07/07/08] 2008 MTWCC 33 Under § 39-71-601(2)(a), MCA, the time requirement for claims filing may be waived for up to 24 months if the claimant has a “lack of knowledge of disability.” In previous cases, the Montana Supreme Court looked to definitions of “disability” found throughout the WCA to determine how to define the term in this context. The court concluded that all of the definitions contained language to the effect that the injury caused a loss of wages or loss of earning capacity. Therefore, a claimant who knows of an injury may nonetheless have no “knowledge of disability” until it affects the worker’s ability to earn a wage.

Tinker v. Montana State Fund [07/07/08] 2008 MTWCC 33Where Petitioner admitted he always related his hip and knee pain back to his June 2005 industrial accident, while he may not have been aware of the severity of the injury, it was not “hidden or invisible” and therefore does not toll the one-year time limitation under the latent injury exception of § 39-71-601(2)(b), MCA.

Tinker v. Montana State Fund [07/07/08] 2008 MTWCC 33 Although § 39-71-601(2), MCA, appears to vest insurers with the sole discretion to waive the time requirement, this Court has previously noted that waiver is not discretionary if the claimant would otherwise qualify for waiver under the statute, as the Legislature may not delegate legislative authority to a nonlegislative body such as an insurance company.

Shelly
v. American Home Assurance Co. [12/06/07] 2007 MTWCC 52
Where Petitioner argued that under Corcoran v. Montana Schools Group
Ins. Authority, 2000 MTWCC 30, the one year statute of limitation
period was not triggered until he required treatment, the Court held
that § 39-71-601, MCA, does not require the presence of symptoms
to commence the statute of limitations. Petitioner’s complaint
filed in district court in 2001 alleging that he suffered from an asbestos-related
condition as a result of his employment with Respondent’s insured
triggered the statute of limitations because this establishes that Petitioner
knew he suffered from an occupational disease as of that date.

[1995]Bain
v. Liberty Mutual Fire Ins. [5/27/04] 2004 MTWCC 45 Waiver
of the one-year limitations period for filing a claim is limited to the
additional two-year period specified by section 39-71-601(2), MCA (1995-2003).
Prior Court decisions placing no restrictions on the time for waiver have
been superceded by the statute.

[1999]Scozzari
v. MSGIA [2/17/04] 2004 MTWCC 7Failure to file a claim within
one year, as required by section 39-71-601(1), MCA (1999), is an absolute
defense to a claim for benefits unless the one-year period is waived.

[1999]Scozzari
v. MSGIA [2/17/04] 2004 MTWCC 7Where
a claimant is aware she was injured and in fact seeks medical care for
her injuries within the one-year filing period prescribed by section 39-71-601(1),
MCA (1999), and where immediately after the industrial accident she was
specifically requested by her employer to file a written workers' compensation
claim, but she refused or failed to do so, claimant is not entitled to
a waiver of the one-year limitations period. § 39-71-601(2), MCA (1999).

[1999]Maddalena
v. Indemnity Ins. [2/27/03] 2003 MTWCC 14Where
a claimant is aware he has a back injury and undergoes back surgery, and
is not prevented by his employer from filing a written claim, there is
no basis for waiving the one-year claim filing requirement. § 39-71-601,
MCA (1999).

[1993]Aaby
v. MMIA [11/5/01] 2001 MTWCC 57 Insurer moved for summary judgment
against minor daughter and ex-wife of decedent, arguing neither filed
claim for death benefits within a year of the decedent's death. The motion
regarding the daughter is denied where no guardian or guardian ad
litem was appointed to represent her interests until this year. Under
Simons-Tollefson v. State Fund, 2000
MTWCC 7, no one is authorized to bring a claim for death benefits
on behalf of a minor child until a guardian or guardian ad litem
is appointed for that purpose and the statute does not begin to run until
appointment. The Court does not reach the merits of the summary judgment
motion against the ex-wife where the insurer has also moved for default
against her, which motion must first be resolved after notice and hearing.

[1999]Kelly
v. Hartford Accident & Indemnity Co. [8/22/00] 2000 MTWCC 50 Although
section 39-71-601(1), MCA (1999), requires a claimant to file a WC claim
within 12 months of injury, the section is a statute of limitations and
affirmative defense which must be asserted by the insurer. Where the injury
occurred in the course and scope of employment, an injured workers' decision
not to file a claim does not take the injury outside the workers' compensation
system.

[1991]Simons-Tollefson
v. State Fund [2/16/00] 2000 MTWCC 7 Insurer moved to dismiss
petition for benefits filed on behalf of minor child of deceased worker
on ground that 39-71-601, MCA (1991), requires written claim "within
12 months...either by the claimant or someone legally authorized to act
for him in his behealf." Against the background of case law and other
statutes, WCC held no one was legally authorized to act for the minor
until a guardian or guardian ad litem had been appointed for the purpose
of seeking workers' compensation benefits, even though the minor's mother
was authorized to act on his behalf in other contexts. Where a guardian
had not yet been appointed, the statute had not yet commenced and the
motion to dismiss was denied.

[1985]McGuin
v. State Fund [12/16/99] 1999 MTWCC 82Claimant who did not
realize until years later that incident occurring during 1986 diving
training resulted in serious ear problems was not barred by his failure
to file a claim within one year of the incident. Because he was unaware
of his condition or that it arose during the work incident, he filed
a timely claim within one year of the diagnosis of his condition.

[1995]Phillips
v. Liberty Northwest Ins. Corp. [10/9/98] 1998 MTWCC 71 Credible
evidence makes it more probable than not that claimant did not file a
claim for back injury within one year of the alleged accident. Supervisor
and safety inspector who would have received claim credibly testified
they had no knowledge of the alleged incident and did not complete or
receive a claim relating to the incident. The medical history claimant
gave to medical providers indicates he did seek treatment around the time
at issue, but failed to mention any particular injury, rather indicating
a gradual onset and giving other descriptions inconsistent with the present
claim.

[1991]Partin
v. State Fund [3/14/97] 1997 MTWCC 11 The question whether claimant
in fact provided a written report to the employer satisfying the one-year
limitations period of section 39-71-601(1), MCA (1991) is for the Workers'
Compensation Court, not the Department of Labor and Industry, because
this question does not involve waiver of the one-year limitations period,
but concerns whether a claim was timely filed.

[1991]Partin
v. State Fund [3/14/97] 1997 MTWCC 11 WCC reversed conclusion
of DOL hearing officer that Association of Service Contractors (AOSC)
accident report allegedly filed by claimant did not satisfy the written
claim requirement of section 39-71-601, MCA (1991). Contention that an
official workers' compensation claim form must be filed was rejected in
Weigand v. Anderson-Meyer Drilling
Co., 232 Mont. 390, 393,
758 P.2d 260, 261-262 (1988), where the Supreme Court held the written
claim must only contain sufficient information to inform the employer
or insurer of the nature and basis of the possible claim and to enable
it to investigate the claim and, if necessary, to prepare a defense.

[1991]
Partin
v. State Fund [3/14/97] 1997 MTWCC 11 WCC reversed conclusion
of DOL hearing officer that reversed Department's order waiving one-year
filing requirement on basis of equitable estoppel. Hearing officer erred
in finding that, even if claimant's testimony were credited, he had not
established elements justifying equitable estoppel of assertion of statute
of limitations. If claimant's testimony is credited, he has established
the requirements of equitable estoppel based on the employer's alleged
representations to him concerning use of health insurance and payment
of additional expenses by the employer.

[1993]Estrada
v. State Fund [2/6/97] 1997 MTWCC
4 WCC No. 9608-7582)
Section 39-71-601, MCA (1993) does not require the claimant to correctly
identify, at his peril, the proper insurer or proper jurisdiction in order
to perfect his claim. The principal purpose of the section is to provide
the employer with sufficient information to enable it to investigate the
claim and, if necessary, prepare any defenses it may have.

[1993]Estrada
v. State Fund [1/14/97] 1997 MTWCC 4 (WCC No. 9608-7582)Claimant,
an Oregon resident employed by an Oregon corporation, was injured in an
automobile accident in Montana. Insurer moved to dismiss where claimant
submitted a claim to his employer, and for Oregon workers' compensation
benefits, within a year following the accident, but did not submit a claim
to a Montana insurer until more than one year following the accident.
Motion denied because section 39-71-601, MCA (1993) provides that within
one year of an industrial accident the claimant must submit a signed claim
"to the employer, the insurer, or the department." By using
the word "or," the statute permits the claimant to submit a
timely claim to any of the entities listed.

Maggs v. State Compensation Ins. Fund [05/16/95] 1995 MTWCC 36 Under section 39-71-601(2), MCA (1989), the Department of Labor and Industry is the exclusive forum for presentment of claimant’s argument that the insurer is estopped from relying on the one-year statute of limitations for claim filing. While the Workers’ Compensation Court may judicially review the Department’s determination, it lacks jurisdiction to conduct a de novo hearing into claimant’s argument that the insurer is estopped where his supervisor allegedly threatened him with termination if he filed a workers’ compensation claim.